A gripping problem

Many accident victims suffer nerve injuries and lose control of their limbs. Most return home untreated because diagnosis is delayed,not many specialists perform these surgeries,and recovery takes long

Seven months ago,23-year-old Mohammad Bani was injured in a motorcycle accident while returning home in Bilauri in north Bihars Purnea district. Bani had a head-on collision with another motorcyclist,who was riding on the wrong side of the road.

A second-year engineering student,Bani was relieved when doctors told him there would be no lasting damage. His sense of relief,however,did not last long.

A few weeks after he was discharged,Bani discovered that he had lost control over his right hand. It was the weirdest sensation. There was no pain. I could stand up,walk and do everything else. But I could not hold a pencil, Bani says.

The worst part was that it took him two months to convince his parents that he had a serious problem,after which they took him to doctors in Kolkata.

Bani was diagnosed with an injury in his brachial plexus system  a network of nerves which controls the function of upper limbs. Despite being a common nerve injury after accidents,it is rarely diagnosed  and often goes untreated as a result. Many young accident victims often do not even visit a doctor before it is too late to regain the ability to control their arms.

After doctors in Kolkata referred him to Delhi,Bani has been admitted to Max hospital in Saket for surgery. I was told in Kolkata that AIIMS and a couple of private hospitals in Delhi perform the surgery. So I came here, a nervous Bani says as doctors prepare him for the procedure.

Another nerve injury victim,38-year-old Bimal Khalko,was in coma for a month after he met with an accident in Ranchi in December. The accident left him with an inability to move his arms.

Khalko spent months going from one doctor to the other  just for a proper diagnosis. It was finally discovered that he had suffered a tear in the nerves in his right arm.

The surgery requires nerves to be grafted from less critical areas of the body to repair the damaged nerves. In some cases,grafting of muscles may also be required. But the procedure requires specialised surgeons  and surgical intervention at the earliest  to ensure recovery in limb function.

Very few specialists in India currently attempt the procedure in government or private hospitals,leading to long waiting periods,and poor rates of recovery. Khalko was told that the waiting period for the surgery was two years.

After he recovered from the coma in December,doctors at a private hospital in Ranchi referred him to AIIMS for further treatment. We have been running around for two months. They diagnosed his injury after several tests, Khalkos wife Sunita says.

But there seemed no sign that the surgery would happen soon. So the family decided to return home. What is the point of waiting here indefinitely? says Sunita.

Neurologists say sometimes infants suffer nerve injuries during the birthing process. While there have been no prominent studies in India,research in the West has shown that stretching the infants neck area during birthing may result in such injuries,particularly for babies who have a high birth weight.

Dr Sandeep Vaishya,a neurosurgeon at Max,Saket,said,With infants,the functional disability is often realised much later than in adults,at least four to five months after birth,by which time it can be too late. We need more awareness among gynaecologists.

He said,This is a highly neglected discipline in neurosurgery,and unfortunately a very commonly required one. While recovery depends on quick response time,the waiting period for surgery stretches into months and years at most centres. The lack of trained personnel and guidelines for the procedure is the main problem.

In Mohammad Banis case,doctors had to remove donor nerves from his arms to repair the tear near his clavicle region. The stitched nerve,Bani hopes lying in his hospital bed,will help improve his hand movements.

My doctor keeps telling me to have patience. But my parents have paid Rs 2 lakh for this procedure. If I cannot even sign my name after this,what is the use? he says.

This desire for quick fixes frequently discourages doctors and hospitals from offering treatment for nerve injuries. Among private hospitals,doctors say,only a few centres offer the procedure,at costs that can reach Rs 1.5 lakh.

Dr V S Mehta,a consultant at Paras Hospital who says he operates on 50-60 nerve injury patients annually,said,At private facilities,patients and doctors want quick results,because money has been put in. But this procedure requires a lot of patience before results can be seen. So it may not be lucrative enough for most practitioners.

At AIIMS,doctors say patients usually report late due to the delay in diagnosis,and an overload of patients leads to even more delays,resulting in a long average waiting times. Dr Sumit Sinha,neurosurgeon at AIIMS Trauma Centre,who has performed about 125 such procedures since 2007,says,Ideally,the surgery should be performed within four to five months of the injury. But I get patients who were injured as long as three years ago. The load is so much,we cannot accommodate everybody in time.

He said the general perception of poor results leads to fewer doctors performing the surgery. We have had 68 per cent improvement in our patients. The numbers show that the condition is very much curable if managed in time, Dr Sinha said.

Dr Satnam Singh Chhabra,neurosurgeon at Sir Ganga Ram Hospital says,Very few doctors attempt it,and even at our centre,patients may have to wait two to three weeks for surgery.

At Apollo Hospital,Dr Rajendra Prasad from the neurosurgery department said that since the most common patients are accident victims,they are commonly taken to government hospitals. We do not have the experience of acute injury patients,but I see one patient a month,who may come post-surgery,when the surgery has not improved his limb function.